Childhood obstructive sleep apnea (OSA) has a prevalence of 2-3%, but the consequences of sleep disorders in children are vastly understudied. Cognitive decrements of vigilance, executive function, and motor coordination are associated with OSA in adults; and importantly, some of these deficits are irreversible with treatment. Brain injury demonstrated by magnetic resonance spectroscopy imaging (MRSI) has been shown in adults with OSA. It remains unclear whether the developing brain has the ability to avoid permanent damage after insults from OSA, and whether neuronal changes occur early. To answer these questions, we initiated a project with a multidisciplinary collaboration of researchers at Johns Hopkins University through the General Clinical Research Center resources. Our preliminary findings, published in the Public Library of Science Medicine, provide strong evidence that childhood OSA is associated with neuropsychological dysfunction. Furthermore, using MRSI, we demonstrated a novel finding of neuronal injury in brain areas important for learning and memory in children with OSA. We speculate that untreated childhood OSA could permanently alter the developing child's ultimate cognitive potential, resulting in a lifetime of health and economic impacts. It remains to be determined if early identification and treatment of childhood OSA can reverse the neuronal and performance deficits identified in this study. The overall hypothesis of the current proposal is that neuropsychological performance dysfunctions and neuronal metabolite alterations of the brain associated with childhood obstructive sleep apnea are reversible with documented treatment. The experimental approach outlined in this application relies on a prospective interventional trial (Specific Aims 1 and 2). The principal investigator will develop skills in clinical investigation in a supervised environment with structured coursework and multidisciplinary interactions guided by talented mentors. Her goals are to 1) become an independent investigator 2) develop multidisciplinary collaborations and 3) contribute important original research to our knowledge of the consequences of childhood OSA. The combined resources of Johns Hopkins Medical Institutions, the pursuit of the outlined aims, and the Mentored Patient-Oriented Research Career Development Award will provide Dr. Halbower the ability to reach her full potential as a funded independent investigator. [unreadable] [unreadable] [unreadable]